I will.
Evidence of meeting #115 for Status of Women in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was task.
A recording is available from Parliament.
Evidence of meeting #115 for Status of Women in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was task.
A recording is available from Parliament.
12:25 p.m.
NDP
Leah Gazan NDP Winnipeg Centre, MB
Do you believe that sexism has impacted decisions made by the current task force?
12:25 p.m.
Chair, Coalition for Responsible Healthcare Guidelines
You know, in all fairness, I think they are equal-opportunity bad guidelines. The prostate cancer guidelines are similarly distasteful to people who know about prostate cancer. I would have to say that I don't see it as being specific to gender. I see as it being specific to incompetence.
12:25 p.m.
Conservative
12:25 p.m.
Conservative
Michelle Ferreri Conservative Peterborough—Kawartha, ON
Thank you, Madam Chair.
Thank you so much to our witnesses for this really important study.
Thank you to my colleagues for sharing their personal stories. There's certainly no shortage of people who have been impacted by breast cancer.
We're here trying to get some information about screening at an earlier age, in particular age 40. I will start with Ms. Farber, who has shared her personal experience of being diagnosed.
You wanted a mammogram at 40, but you were discouraged. What was the reason for this?
12:25 p.m.
As an Individual
When I talk about this, I want to really make it clear that this wasn't a case where I was advocating hard and my doctor denied me something. Every year I go to see my family doctor. There are certain things we've done—a pap, for example. By the way, I've never been asked about my personal preference or my values and whether or not I want to have a pap. That's kind of interesting to me.
It was just about the things that needed to be done. I needed blood work. I needed my tetanus shot. When I asked if I needed to have a mammogram, since I was 40, the response was, no, the Canadian guidelines now say that you don't need to have one until you're 50. I asked again later on, I believe when I was 45, and received a very similar response. It was a very casual discussion. I think that's probably more reflective of the types of conversations that are happening between patients and doctors in busy family doctor offices.
I was also told that I had no family history, and therefore I was very low risk, which I have now found out is not true. We know that the majority of breast cancers that are found in women are found in women without a family history.
12:25 p.m.
Conservative
Michelle Ferreri Conservative Peterborough—Kawartha, ON
What's interesting there is how you kind of rationalized that you didn't have to advocate hard. I find that bizarre when we're dealing with our doctors. It's our body. We live with it all day, yet we have to sort of fight to be heard. I feel that a lot from folks.
Dr. McKerlie, you said that the guidelines currently are based on a study from the 1980s, and this study is flawed. How is it flawed?
12:25 p.m.
As an Individual
Thanks for the question.
A number of things went on, including a randomized controlled trial, which is supposed to be the gold standard. There were issues with that randomization. There are papers that have shown that to be the case. There were other issues as well as that non-randomization.
Of course, one of the main things, even if the study was equal and perfect, was the fact that they used 98% white women—Dr. Narod agreed in the House of Commons last time—when we know that this is not reflective of the Canadian population today.
12:25 p.m.
Conservative
Michelle Ferreri Conservative Peterborough—Kawartha, ON
Thank you for that.
I think what's kind of shocking for a lot of provinces is that you can only get a screening mammogram if you have a referral from family physicians. One in four Ontarians are without a family doctor and 6.5 million Canadians don't have a family doctor. On the Ontario website, it says that if you don't have a doctor, phone this number—like you're going to get one. I think that's pretty hysterical.
This is a big problem. I know that you can self-refer in some provinces where that's changed, but the reality is that, if the wait-list is too long and there's a backlog, what does that even do?
I have a question for whoever wants to answer it, but I guess I'd look to Dr. Rushton on this. If we move this number back to 40 right now...but even say that it is 50. You don't even get it at 50, because there are not enough doctors. There are not enough spaces. I think even moving it back to 40, you might not even get it at 40, if I do the math.
I'm not sure who wants to answer that.
12:30 p.m.
Professor of Radiology, Faculty of Medicine, University of Ottawa, As an Individual
Maybe I could take it.
12:30 p.m.
Conservative
The Chair Conservative Shelby Kramp-Neuman
—there are three individuals on the screen behind you who do want to chime in. I don't think you can see the screen from there.
12:30 p.m.
Professor of Radiology, Faculty of Medicine, University of Ottawa, As an Individual
I'd be happy to comment on that. It's a great question, and it addresses some of the concerns from Manitoba.
In Ontario we are planning, and we are allocating resources, to increase the screening program to include women in their forties. We know, based on British Columbia and Nova Scotia data, that the first screen has the highest abnormal recalls. Then it drops to the same if you're in your forties, fifties or sixties. It's not higher if you're in your forties.
You do need to allocate resources, but we are going to be able to do that in Ontario by increasing the training of technologists, more mammography units and more access to these diagnostic tests. This will be beneficial.
12:30 p.m.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you for that.
I know we have a lot of information that we're trying to get out. Unfortunately, the five minutes is exhausted. If any of you could submit any additional information that you have in response to that question, that would probably be helpful for the analysts.
I'd now like to welcome Anita.
You have five minutes.
12:30 p.m.
Liberal
Anita Vandenbeld Liberal Ottawa West—Nepean, ON
Thank you very much. I just have to say that I think this is probably one of the most impactful panels we've had in this committee, and I am incredibly grateful that we have had the ability to create the platform to bring your voices into a process that clearly has been lacking those voices.
Ms. Farber, I just wanted to say to you that I have a feeling that lots of us around this table, and those who are watching, are thinking precisely what you just described. I think you're describing what is probably, in reality, the lived experience of most women. Thank you so much for that testimony. I'm so sorry for what you had to go through.
I want to start my questions with Dr. Seely, because you mentioned that the task force was looking at obsolete technologies and old reports, sometimes decades old, and that it ignored recent observational trial data I think you said that 2.6 million women were in that. I just wonder if you could elaborate a bit on the methodology and the reports and the actual data and information that were addressed by the task force and how that may have led to the flawed results of the task force.
12:30 p.m.
Professor of Radiology, Faculty of Medicine, University of Ottawa, As an Individual
One of the recommendations that I and two other expert advisers made to the evidence review team is that using the old randomized trials would really be an error in looking at the new evidence. The reason for that is that the methodology called GRADE, which Dr. Appavoo referred to, automatically characterizes that as the highest quality evidence. It doesn't matter if you include another 90 studies after those randomized trials; it automatically downgrades that.
What we showed in our evidence review is that, if you look at the observational trials, you see that the benefit of reducing mortality was 50%. It is a huge benefit. However, if you only look at the randomized controlled trials, you see that it lowered it to about 20%. This methodology, which was insisted on by the task force, downgraded all of these very large extensive trials that included more modern treatments. That was one of the points that we recognized they had disregarded.
12:30 p.m.
Liberal
Anita Vandenbeld Liberal Ottawa West—Nepean, ON
You also briefly said that you had a non-disclosure on inputs that you would want to provide to the task force. Can you elaborate on that? It doesn't seem quite transparent.
12:30 p.m.
Professor of Radiology, Faculty of Medicine, University of Ottawa, As an Individual
The task force had a call for experts to be consultants and advisers, but the condition of being one of those advisers had to be that you signed a form that removed any possibility of your disclosing what the process was and was involved with. These experts also were non-voting members. I decided that was a risk that I was not willing to take, but I was able to work with the evidence review team and to really see what the working group was insisting on by this evidence review.
I could see their interference, really, and their direction, which really hampered the evidence review team from doing the work that had been proposed, which was to look at the recent evidence, which was what was done in the United States. They only looked at studies from 2016 on. This protocol was not adopted by the working group, and I think that is one of the reasons we have these recommendations.
12:35 p.m.
Liberal
Anita Vandenbeld Liberal Ottawa West—Nepean, ON
In fact, there was a disincentive for experts to participate in this. That's quite alarming.
I did want to go quickly to Ms. Van Dusen, because—
12:35 p.m.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Anita, just so you're aware, Dr. Turner does have her hand up as well. I didn't know if you saw it.
12:35 p.m.
Liberal
12:35 p.m.
Liberal
Anita Vandenbeld Liberal Ottawa West—Nepean, ON
I did want to ask Ms. Van Dusen quickly about international data. You said that there was international evidence that was not taken into account. Could you explain that?
12:35 p.m.
Advocacy Manager, Prevention and Early Detection, Canadian Cancer Society
We have a whole list of data that we informed our recommendations on, both in Canada and internationally. I'd be happy to provide that.